First of all we would introduce our conception of Appropriateness. What is appropriateness from a medical point of view? The medical doctor acts based on criterion of effectiveness of the treatments respecting the autonomy of the person. The prescriptions and treatments have to be inspired-to-date scientific knowledge and experience, taking into account the appropriate use of resources, always pursuing the benefit of the patient according to criteria of equity.
Equity is combining limited resources with justice and solidarity, best use of resources, best cost benefit ratio without favoring cost saving and performance cuts. It’s also necessary to use methodologically correct procedures and fairly objective methods for measuring results. Rationalize resources and not ration them.
What is Effectiveness? We mean Effectiveness in clinical practice or rather the degree to which health improvements are actually achieved within.
What we mean by Efficiency? It is the relationship between the resources employed and the intervention provided considering the mode of application of resources.
What we mean by Efficacy? It is the ability of science and health technology to produce improvements in health when used in the most favorable conditions.
What are Clinical Needs? They are services needed by the patient to achieve the highest degree of improvement included complete recovery.
The psichopatological target are: Theory of Mind, Executive Functions and Deficit of Central Coherence.
In our program of rehabilitation Neuro-Cognitive Trainings (NCT), and especially Social Skills Training (SST) are the most effective interventions designed to improve social competence and other cognitive abilities of patients with schizophrenia. Basic Social Skills is a training with specific exercises for each aspect. For example: listening; telling a short story accompanied by pictures or movies and assessing the listening skills of the participants; asking for help; thanking; making friends, management of aggressiveness; accomplishing a task, etc.
The Problem Solving training teaches how to solve problems of increasing difficulty, according to the classical method.
The training teaches the ability to recognize, understand, communicate and mentalise one’s own emotions and the one’s of the others.
Communication training exercise Verbal, para-verbal and nonverbal communications skills.
Assertivity is being self-assured and self-confident, valuing yourself and your rights, needs and wishes (remembering that they are as important as anyone else’s), expressing negative thoughts and feelings in a healthy and positive manner, receiving criticism and compliments positively, learning to say “no” when you need to.
Neurocognitive Training is a complex exercise of Attention, Concentration and Working Memory
For investigating the result of the improvement, firstly we examine the efficacy of the cognitive intervention based on SST and NCT approaches of our rehabilitation program applied in two different Residential Mental Health Services; secondly we assess how NCT and SST implement Social Skills in real life and how they guarantee generalization and persistence over time of eventual improvements. We compared this result with two other Residential Mental Health Services that didn’t apply this program and used to do a generic rehabilitation intervention based on social recreational activities plus support of daily life abilities.
About the methodology: Thirty-four adult inpatients (from 18 to 55 years of age) with DSM V based diagnoses of schizophrenia were assigned to three different groups: structured rehabilitation program for 24 months (IPT-a group); structured rehabilitation program for 24 months (IPT-b group); generic intervention for 24 months (IPT-c group). The last one was considered as a control group. Basic and outcome measures were neuro cognition and social skills assessment. We divided the Social Skills Training in five different groups: Problem Solving, Verbal and Nonverbal Communication, Assertivity, Management of emotions and impulsivity and Basic Social Abilities.
Still about the results. Patients with schizophrenia can clearly improve their social competence with NCT and SST to different degrees. IPT-a, IPT-b groups proved an evident improvement regarding deficits of cognitive functions and social competence. IPT-a group and IPT-b group show a higher level of generalization and persistence of improvements. IPT-c group shows no satisfying results concerning cognitive functions, social and relational competences.

IN CONCLUSION: The most effective intervention on cognitive deficits, social and relational competences will benefit from a structured program based on cognitive remediation and social skills training. We hope to implement and systematically apply structured intervention programs in Residential Mental Health Services. We hope to have better assessment scales, too.